[1]张雨,李钧,李志民,等.股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折内固定失效的危险因素分析[J].中医正骨,2022,34(02):3-6.
　ZHANG Yu,LI Jun,LI Zhimin,et al.Analysis of risk factors for the failure of internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):3-6.
点击复制

股骨近端防旋髓内钉内固定治疗老年股骨转子间骨折内固定失效的危险因素分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第34卷
期数:
2022年02期
页码:
3-6
栏目:
临床研究
出版日期:
2022-02-20

文章信息/Info

Title:
Analysis of risk factors for the failure of internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged
作者:
张雨; 李钧; 李志民; 黄鹤; 水明斌
浙江新安国际医院,浙江 嘉兴 314000
Author(s):
ZHANG Yu; LI Jun; LI Zhimin; HUANG He; SHUI Mingbin
Zhejiang Xin'an International Hospital,Jiaxing 314000,Zhejiang,China
关键词:
髋骨折;  股骨转子间骨折;  老年人;  骨折固定术; 内;  股骨近端防旋髓内钉;  内固定失效;  危险因素
Keywords:
hip fractures;  femoral intertrochanteric fracture;  aged;  fracture fixation; internal;  proximal femoral nail antirotation;  failed internal fixation;  risk factors
摘要:
目的:探讨股骨近端防旋髓内钉(proximal femoral nail antirotation,PFNA)内固定治疗老年股骨转子间骨折内固定失效的危险因素。方法:选取采用PFNA内固定治疗的100例老年股骨转子间骨折患者的病例资料,从病历系统中提取患者的性别、年龄、致伤原因、合并基础疾病、骨折分型、麻醉方式、手术时间、术中出血量及并发症发生情况等信息,并提取患者术后1个月的正侧位X线片,评估患者骨折复位质量并测量尖顶距。将发生内固定物断裂、术后6个月骨折不愈合、螺旋刀片松动退出或切割股骨头颈部等1种及以上并发症的患者纳入内固定失效组,将未发生上述并发症的患者纳入内固定有效组。先对2组患者的相关信息进行单因素对比分析,然后将其中组间差异具有统计学意义的因素作为自变量,将内固定是否有效作为因变量,进行多因素Logistic回归分析。结果:内固定有效组纳入79例,内固定失效组纳入21例。2组患者的合并基础疾病、骨折分型、骨折复位质量、尖顶距比较,组间差异均有统计学意义(χ2=55.598,P=0.000; χ2=14.731,P=0.000; Z=-6.162,P=0.000; χ2=46.296,P=0.000); 2组患者的性别、年龄、致伤原因、麻醉方式、手术时间、术中出血量比较,组间差异均无统计学意义(χ2=3.320,P=0.068; χ2=0.073,P=0.964; χ2=0.485,P=0.785; χ2=0.392,P=0.822; χ2=0.705,P=0.401; χ2=0.436,P=0.509)。Logistic回归分析结果显示,合并2种及以上基础疾病、不稳定型骨折、骨折复位质量差及尖顶距≥30 mm是PFNA内固定治疗老年股骨转子间骨折内固定失效的危险因素(β=1.596,P=0.022,OR=6.134; β=2.346,P=0.000,OR=6.228; β=1.875,P=0.010,OR=6.147; β=2.013,P=0.004,OR=5.101)。结论:合并2种及以上基础疾病、不稳定型骨折、骨折复位质量差及尖顶距≥30 mm是PFNA内固定治疗老年股骨转子间骨折内固定失效的危险因素。
Abstract:
Objective:To explore the risk factors for the failure of internal fixation with proximal femoral nail antirotation(PFNA)in treatment of intertrochanteric fractures(ITFs)in the aged.Methods:The medical records of 100 aged patients who underwent PFNA internal fixation for treatment of ITFs were selected,and their information including gender,age,cause of injury,combined underlying diseases,fracture classification,anesthesia method,operative time,intraoperative blood loss and postoperative complications were extracted from the electronic medical record system(EMRS),and the anteroposterior and lateral X-ray films taken at 1 month after the surgery were extracted for evaluating the ITFs reduction outcome and measuring the tip-apex distance(TAD).Patients with one or more complications,such as breakage of internal fixator,fracture nonunion at 6 months after the surgery,loosening and withdrawal of spiral blade and cleaved femoral head and neck,were assigned into the ineffective internal fixation group(21 cases),and the ones without such complications into the effective internal fixation group(79 cases).Single-factor analysis was conducted on the information of patients in the 2 groups,followed by multi-factor logistic regression analysis by taking the factors with significant differences between the 2 groups as independent variable,and whether PFNA internal fixation was effective as dependent variable respectively.Results:There was statistical difference in combined underlying diseases,fracture classification,ITFs reduction outcome and TAD between the 2 groups(χ2=55.598,P=0.000; χ2=14.731,P=0.000; Z=-6.162,P=0.000; χ2=46.296,P=0.000).There was no statistical difference in gender,age,cause of injury,anesthesia method,operative time and intraoperative blood loss between the 2 groups(χ2=3.320,P=0.068; χ2=0.073,P=0.964; χ2=0.485,P=0.785; χ2=0.392,P=0.822; χ2=0.705,P=0.401; χ2=0.436,P=0.509).The results of logistic regression analysis revealed that the combination of two or more underlying diseases,unstable ITFs,unsatisfactory reduction of ITFs and TAD of ≥30 mm were the risk factors for the failure of internal fixation with PFNA in treatment of ITFs in the aged(β=1.596,P=0.022,OR=6.134; β=2.346,P=0.000,OR=6.228; β=1.875,P=0.010,OR=6.147; β=2.013,P=0.004,OR=5.101).Conclusion:Combination of two or more underlying diseases,unstable ITFs,unsatisfactory reduction of ITFs and TAD of ≥30 mm are the risk factors for the failure of internal fixation with PFNA in treatment of ITFs in the aged.

参考文献/References:

[1] IBRAHIM I,APPLETON P T,WIXTED J J,et al.Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures:are helical blades to blame?[J].Injury,2019,50(4):926-930.
[2] MAUPIN J J,STEINMETZ R G,HICKERSON L E.A percutaneous threaded wire as a clamp technique for avoiding wedge deformity while nailing intertrochanteric femur fractures[J].J Orthop Trauma,2019,33(7):e276-e279
[3] 张文昌.股骨近端防旋髓内钉内固定对股骨粗隆间骨折老年患者术后髋关节功能及生活质量的影响[J].中国药物与临床,2018,18(6):976-978.
[4] 李祥义,王汝武,毕超,等.股骨近端防旋髓内钉内固定治疗老年不稳定性股骨粗隆间骨折53例临床观察[J].山东医药,2020,60(34):89-91.
[5] 左思力.半髋关节置换和股骨近端防旋髓内钉内固定治疗高龄患者髋部骨折的风险评估[J].中国组织工程研究,2019,23(28):4440-4445.
[6] 陈敬煌,王贤月,彭方城,等.髋关节置换术治疗股骨近端防旋髓内钉内固定失败[J].临床骨科杂志,2020,23(3):447-448.
[7] 万家兴,王凯利,宋雪,等.股骨粗隆间骨折行股骨近端防旋髓内钉内固定术后失败的原因分析及手术经验总结[J].四川医学,2018,39(4):449-452.
[8] BAUMGAERTNER M R,CURTIN S L,LINDSKOG D M,et al.The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip[J]. J Bone Joint Surg Am, 1995,77(7):1058-1064.
[9] 蔡雨卫,冯俊涛,陈羽,等.尖顶距与股距尖顶距对亚洲型股骨近端髓内钉内固定治疗股骨转子间骨折术后并发症的预测价值比较[J].中国修复重建外科杂志,2020,34(11):1359-1363.
[10] 郝有亮,张志山,周方,等.股骨近端防旋髓内钉固定治疗股骨反转子间骨折内固定失败的危险因素分析[J].中华创伤骨科杂志,2019,21(9):771-776.
[11] 谢明锐,刘瑞.股骨近端防旋髓内钉内固定治疗股骨粗隆间骨折的手术效果及预后分析[J].内蒙古医学院学报,2019,41(1):23-26.
[12] 李锐军,林浙龙,周正茂,等.股骨近端防旋髓内钉治疗老年股骨粗隆间骨折的隐性失血特点及影响因素[J].海南医学,2018,29(10):1366-1368.
[13] 陈鹏,傅德皓.股骨近端防旋髓内钉治疗老年股骨转子间骨折内固定失败原因分析[J].中国修复重建外科杂志,2019,33(10):1270-1274.
[14] 彭硕,农新盛,黄超,等.整复后内侧壁骨折并空心螺钉固定在股骨转子间骨折合并后内侧壁骨折老年患者中的应用效果[J].广西医学,2019,41(3):289-292.
[15] 王路,林文军,朱雄白,等.Wagner SL假体柄半髋置换术治疗内固定失败的高龄股骨转子间骨折[J].中华创伤杂志,2018,34(8):728-733.
[16] 侯志华.股骨近端防旋髓内钉内固定术与胫骨结节牵引术治疗老年股骨粗隆间骨折效果对比[J].中国药物与临床,2020,20(21):3624-3625.
[17] 吕阳,王海洲,钟的桂,等.侧卧位人工牵引和平卧位牵引床牵引对闭合复位股骨近端防旋髓内钉内固定治疗老年不稳定股骨转子间骨折的比较[J].中国组织工程研究,2018,22(19):3110-3116.
[18] 刘志勤,张锡平,王伟锋,等.侧卧位无牵引床复位加长型髓内钉内固定治疗股骨粗隆下骨折疗效观察[J].中国骨与关节损伤杂志,2020,35(10):1067-1068.
[19] 唐胜斌.股骨近端防旋髓内钉小切口治疗老年股骨粗隆间骨折的效果和安全性分析[J].实用老年医学,2019,33(1):49-52.
[20] 蔡雨卫,冯俊涛,陈羽,等.尖顶距与股距尖顶距对亚洲型股骨近端髓内钉内固定治疗股骨转子间骨折术后并发症的预测价值比较[J].中国修复重建外科杂志,2020,34(11):1359-1363.
[21] 牛国庆,吴峰,彭智浩,等.股骨粗隆间骨折PFNA内固定失效手术因素分析[J].中国临床解剖学杂志,2020,38(6):728-734.
[22] 李炜,罗斌,沈鹏.股骨粗隆间骨折髓内钉固定不同尖顶距水平对疗效的影响[J].中国中医骨伤科杂志,2018,26(10):28-31.

相似文献/References:

[1]温超海,何忠,李永斌,等.闭合复位伽玛钉改良成锁定支架内固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(11):32.
[2]孙群周,阮成群,李光明,等.股骨近端防旋髓内钉内固定治疗 老年不稳定型股骨转子间骨折[J].中医正骨,2015,27(10):20.
[3]方策,倪新宇,王宏伟,等.迟氏正骨手法复位单臂外固定支架固定治疗 老年股骨转子间骨折[J].中医正骨,2015,27(10):22.
[4]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[5]姜自伟,黄枫,郑晓辉,等.老年股骨转子间骨折患者的围手术期风险评估与控制[J].中医正骨,2015,27(08):33.
[6]倪新宇,方策.外固定器治疗股骨转子间骨折的研究进展[J].中医正骨,2015,27(07):48.
[7]王智勇,陈柯,田可为,等.联合应用摇杆技术和钳夹技术微创治疗股骨转子部骨折[J].中医正骨,2015,27(05):36.
[8]郑艳峰,吴勋,周荣昌,等.股骨近端防旋髓内钉内固定与动力髋螺钉内固定治疗 老年股骨转子间骨折的对比研究[J].中医正骨,2015,27(04):24.
　ZHENG Yanfeng,WU Xun,ZHOU Rongchang,et al.A comparative study of proximal femoral nail antirotation internal fixation versus dynamic hip screw internal fixation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):24.
[9]龚江浩.股骨近端防旋髓内钉联合抗骨质疏松药物治疗 不稳定型老年股骨转子间骨折的临床观察[J].中医正骨,2015,27(04):29.
　GONG Jianghao.A combination therapy of proximal femoral nail antirotation and anti-osteoporotic drugs for the treatment of unstable femoral intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):29.
[10]张磊,柴浩.股骨近端髓内钉与动力髋螺钉固定治疗 老年股骨转子间骨折的系统评价[J].中医正骨,2015,27(03):27.
　ZHANG Lei,CHAI Hao.Systematic review on proximal femoral nail versus dynamic hip screw fixation for treatment of intertrochanteric fracture in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):27.
[11]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[12]李书良,李启义,李建明,等.锁定钢板内固定联合自体髂骨植骨治疗 股骨近端粉碎性骨折[J].中医正骨,2015,27(05):31.
[13]王国柱,肖斌,孙鹏程,等.带大转子柄人工股骨头置换术治疗高龄股骨转子间不稳定性骨折[J].中医正骨,2016,28(05):54.
[14]杨杰,张剑.人工半髋关节置换术治疗老年股骨转子间骨折[J].中医正骨,2018,30(11):71.
[15]江涛,江林,史俊德,等.多功能牵引床骨牵引治疗高龄股骨转子间骨折[J].中医正骨,2020,32(07):51.
[16]翟亚业,秦晓彬,李森,等.老年股骨转子间骨折股骨近端防旋髓内钉内固定术后髋关节功能恢复的影响因素分析[J].中医正骨,2022,34(12):29.
　ZHAI Yaye,QIN Xiaobin,LI Sen,et al.Factors affecting hip functional recovery in the elderly with intertrochanteric fractures treated with proximal femoral nail antirotation internal fixation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2022,34(02):29.
[17]鲍雷,冯冬前,余加生,等.骨水泥强化型与传统型股骨近端防旋髓内钉内固定治疗老年骨质疏松性股骨转子间不稳定性骨折的对比研究[J].中医正骨,2023,35(10):16.
　BAO Lei,FENG Dongqian,YU Jiasheng,et al.A comparative study of bone cement-reinforced versus conventional proximal femoral nail antirotation internal fixation for treatment of unstable osteoporotic intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(02):16.
[18]柳松,张德祥.老年股骨转子间骨折患者股骨近端防旋髓内钉内固定术后颈干角丢失的影响因素分析[J].中医正骨,2023,35(11):5.
　LIU Song,ZHANG Dexiang.Analysis of factors influencing the loss of collodiaphyseal angle after internal fixation with proximal femoral nail antirotation for treatment of intertrochanteric fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(02):5.
[19]谭哲,邓光桦.股骨近端防旋髓内钉联合捆扎内固定治疗股骨转子间骨折有效性和安全性的mETA分析[J].中医正骨,2023,35(11):29.
　TAN Zhe,DENG Guanghua.Clinical outcomes and safety of proximal femoral nail antirotation combined with bundling internal fixation for treatment of intertrochanteric fractures:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(02):29.
[20]罗程,宋忱,龚健,等.老年髋部骨折手术延迟的影响因素分析及风险预测模型构建[J].中医正骨,2024,36(02):32.
　LUO Cheng,SONG Chen,GONG Jian,et al.Influencing factors and a risk forecasting model of delayed operation for hip fractures in the aged[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(02):32.

备注/Memo

备注/Memo:
通讯作者:水明斌 E-mail:987998559@qq.com
更新日期/Last Update: 2022-02-20